David Z. Hirsch's Blog

A medical review of the documentary Down to Earth with Zac Efron

A medical review of the documentary Forks Over Knives

A medical review of the documentary In Defense of Food

A medical review of the documentary The Truth About Alcohol

A medical review of the documentary (Un)well

A medical review of the documentary Why Are We Getting So Fat?

And the video 5 Netflix Health Documentaries Worth Streaming

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Published on March 09, 2021 06:35

A medical review of the documentary (Un)well

(Un)well

This 6-part documentary series explores current health fads that have been co-opted by companies looking to cash in. The benefit data for most are lacking beyond the expected placebo effect, but individuals interviewed in each episode passionately insist the particular therapy discussed has greatly improved or even saved their lives.

Should you view this series as a list of options to consider for your health or as an exploration of power, money, and exploitation on a massive scale? That depends on your perspective.

Each episode begins with a warning that this series is “designed to entertain and inform” so you know the producers don’t want to be sued when you try bee therapy and go into anaphylactic shock or try ayahuasca and have a seizure. “You should always consult your doctor,” they say. Yes, always good advice, but the series comes off as entertainment and promotion rather than entertainment and information.

At some point in each episode, they do interview at least one doctor or scientist who acts as the minority voice of reason (Boo! Boring!), but the majority of each episode is focused on promotion of the therapy. Inevitably, we are bombarded with a snake-oil-salesman list of all the symptoms and diagnoses that this therapy could (in theory) relieve.

We also meet the people behind the companies set up to cash in, many of whom are True Believers who use the product on themselves. The theme becomes obvious: the more desperate, the more willing to try anything, the more likely to be exploited.

One can’t help but root for the emotionally scarred individuals looking for something, anything, to make them feel better. Western medicine has clear limitations, and CAM (complementary and alternate medicine) therapies can be an option for those in need of comfort. In each case, we find companies that have stepped in to create multi-million dollar industries with decidedly mixed results and several deaths left in the wake of its destruction.

Episode 1. Essential oils: “like a cult” vs. “cured my cancer”

Essential oils are extracts from plants with scents many find comforting. After a “Holistic Nurse and Clinical Aromatherapist” spends time with a patient trying different scents to find the right blend, the patient states that he feels better.

“I don’t know if it’s the attention or the oils but I feel better.”

Well said. Others are not quite so insightful as correlation becomes confused with causation. One individual states that he had cancer, took the oils, and now doesn’t have cancer. Despite the many complex factors involved, he is convinced essential oils are what cured his cancer.

The second part of the episode focuses on doTERRA and Young Living, two companies that hawk essential oils as multilevel marketing companies. If you watched Dirty Money, another Netflix documentary series, you already know about Herbalife, a similar predatory multilevel marketing company that uses the same pyramid scheme to sell a worthless product and defraud its own employees.

To work for Young Living, you have to spend hundreds of dollars per month on inventory. Only 6% of employees make more than $1 per month, and most go into debt. To make actual money, you can’t just sell the product, you need to convince your network (friends and family) to join the company so you can take a portion of their profits. The collateral damage is highly destructive. A class-action lawsuit is ongoing.

Episode 2. Tantric sex: “cultural appropriation” vs. “orgasmic energy”

On the surface, it is difficult to complain about “good sex with the promise of wellness.” Even if you don’t get well, at least you’ve still got the good sex. But much like yoga, tantric sex has been westernized from the original Indian tradition to become something else entirely.

We meet Sasha Cobra, who charges $225 per hour by phone/skype (or quite a bit more in person). She has a soothing voice, a gentle touch, and promises full-body orgasms. Is she an intimacy coach or a new age prostitute?

Before we can figure it out, we shift to a cult in Thailand where the charismatic male leader views assault and rape as “sexual healing” and “enlightenment.” It’s all horrifying. By the time we return to Sasha talking about how empowering it is to “give women permission to expresses their sensuality,” she looks quite good in comparison.

Sasha calls herself an “energy worker” rather than a sex worker. Whatever she is, she is certainly cashing in after this extended advertisement.

Episode 3. Bulking up with breast milk: “sewer water” vs. “liquid gold”

Many lactating women will donate excess breast milk to neonatal ICUs in hospitals to help struggling new babies. Or donate it to adopted babies whose new mothers are not lactating. All very noble, but there is quite a bit of money to be made by selling it on the internet, so that happens.

Who buys it? Among others, we meet a bodybuilder convinced that human milk is more “natural” than anabolic steroids and a cancer survivor that has correlated his ingestion of human milk to reductions in his PSA level (a marker for prostate cancer). As with everyone else we meet, there is no scientific basis to their beliefs, but data is sparse, so who’s to say?

Dr. Sarah Keim, for one. She notes that human milk purchased on the internet is often cut with cow milk or baby formula, subject to environmental contaminates, and if not transported correctly will often have pathogenic bacteria like E. Coli and Salmonella.

“Unless you have a lab in your kitchen,” she quips, “you really can’t test the milk yourself and know that it’s completely safe.”

Given all the babies who need it, human milk not an “ethically-grounded nutritional source” for adults.

And, you know, yuck.

Episode 4. Fasting: “risking death” vs. “the body can heal from virtually anything if (you) fast long enough”

The trend of not eating for most of the day was made popular by Silicon Valley biohackers who like to fast for most of the day to “improve performance.”

Grasping the general theme by this point, I kept wondering how someone could possibly exploit fasting for personal gain. Why would anyone pay someone else to help them not eat? Oh, how naïve I am. Turns out there are long-term water-only fasting facilities you can go to where they will charge you money to watch you intentionally starve yourself for days at a time.

TrueNorth is a medically supervised long-term (5-40 days) water-only fasting company. Yes, not eating will absolutely help you lose weight, but it will also catabolize your organs, and the re-feeding after a prolonged fast can cause abnormalities in electrolytes causing loss of consciousness and cardiac arrest.

But at least they monitor you and help you survive the process unlike Tanglewood Wellness Center (in Costa Rica), which is not medically supervised. The director, Loren Lockman, proudly eschews the “burden” of medical training and calls medicine the “third leading cause of death” (!) I was disappointed that he didn’t inform us what he thinks the first two are. Is it exercise? Not smoking? Dang, is it aliens?

On a more serious note, we meet a woman whose husband died at the center. Loren takes no responsibility for the death, stating that he is right because he knows that he is right, a difficult argument to counter. He claims with no evidence that fasting cures heart defects, arthritis, cancer, and blindness. Yes, blindness. On the off chance you are still not convinced of his confidence, he concludes that if God told him that he had the wrong diet, his response would be…

“Thanks for your opinion. I’m good.”

Episode 5. Ayahuasca: “induce psychotic outbreaks” vs. “heal psychic wounds”

In the indigenous Peruvian tradition, the Shaman drinks ayahuasca, and the song he sings is the medicine. Not surprisingly, Westerners want to drink the drug themselves, creating a tourist boom in Peru. Here is another indigenous tradition transformed by Western influence (AKA corrupted by money).

Unlike the other fads, there is not some mild placebo effect exaggerated by True Believers or those looking to cash in. Ayahuasca is a serious drug that induces protracted vomiting followed by an altered state of consciousness.

The issue at hand: does this drug help people with substance abuse and/or mental health problems like PTSD and depression? Some evidence suggests that it may (click the above links to see for yourself). That’s presuming it doesn’t kill you first: risks include seizures, serotonin syndrome, psychotic outbreaks, and malignant hypertension.

Like with marijuana, the DEA has (mis)characterized ayahuasca as schedule 1. I, for one, would like to see larger controlled studies. For the more severe, refractory cases, ayahuasca may be a risk worth taking.

Episode 6. Bee sting therapy: “exploited by the culture of belief” vs. “a wonder cure”

Using bee stings as acupuncture needles, a new industry has arrived to pray on the hopeless. Unsubstantiated claims include healing for multiple sclerosis, arthritis chronic pain, arthritis, and the always vague chronic Lyme disease.

Neurologist Dr. Steven Novella describes bee venom is a witches’ brew of toxins and chemicals developed by nature to cause pain and destroy tissue. OK, but on the other hand, check out the slick marketing by The Heal Hive:

“Use science as a friend but bee venom as the medicine.”

I like friends and medicine! What I don’t like is watching people kill honey bees (yes, they always die after they sting you), especially as bee colonies are collapsing around the world.

Conclusion

As long as people suffer, they will be willing to try new therapies despite a lack of convincing data and despite risks of adverse effects or death. Some therapies may one day prove beneficial, others are useless or detrimental. If this documentary teaches us anything, it’s that whatever the actual effect, all therapies can be exploited for financial gain.

I found it difficult to get through many of these episodes. The individual anguish and despondency mixed with flagrant profiteering left me with a dim view of humanity. The focus on hearsay with only a sprinkle of science created a false balance that permeated every episode.

I’ll leave the final word to my new favorite neurologist, Dr. Steven Novella:

“There is a standard in healthcare, and it exists for a reason. It’s so that we don’t exploit desperate patients by offering them treatments that really don’t have a reasonable chance of working. But they’ll pay for out of their desperation.”

(Un)well is available for streaming on Netflix.

About the Author

David Z Hirsch, MD is the pen name of the author of the award-winning novels Didn’t Get Frazzled and Jake, Lucid Dreamer, both available for purchase on Amazon or may be read for free with Kindle Unlimited. Didn’t Get Frazzled is also available on Audible.

He is an internal medicine physician with an active practice in Maryland.

Check out my other reviews:

A medical review of the documentary Down to Earth with Zac Efron

A medical review of the documentary Forks Over Knives

A medical review of the documentary In Defense of Food

A medical review of the documentary The Truth About Alcohol

A medical review of the documentary Why Are We Getting So Fat?

And the video 5 Netflix Health Documentaries Worth Streaming

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Published on August 27, 2020 15:41

A medical review of the documentary Down to Earth with Zac Efron

Down to Earth with Zac Efron

Billed as a travel show that explores healthy, sustainable ways to live, this documentary series seems more like a meandering bromance travelogue. It brims with edible and psychogenic plants, mystic wellness centers, gratuitous adrenalin, and sporadic fangirl shrieks. Yet, they manage to punctuate each episode with enough emotional heft to keep you clicking through to the end.

Zac Efron and Darin Olien are exactly the sort of folks you would expect to populate Los Angeles, a former teen superstar looking for deeper meaning and a self-proclaimed superfood guru with a podcast offering exactly that. Zac reached out to Darin, cue magic, and off they go, traveling the world on a quest to explore healthy living. Their chemistry is endearing even if the science bends and sways a bit.

Here’s the breakdown by episode:

Iceland

Zac and Darin learn about renewable energy but also do a bit of sightseeing and have a fire and ice massage, which is definitely not just an excuse to look at these guys shirtless. At one point, the guys go to a fancy restaurant that serves traditional, contemporary Icelandic dishes where Zac is disturbed that his food is “dung smoked.” No one bothers to explain why, but pre-modern Icelanders didn’t do it for flavor. Back in the day, they used dung as a fuel source because the early Viking settlers had cleared the forests for cattle and charcoal production.

In terms of accessing renewable energy, modern Iceland has come a long way. As recently as the 1970s, Iceland was dependent on imported coal and oil. Now they get all their energy needs from four geothermal plants and ten hydroelectric plants. In 2017, Iceland used 0% fossil fuels (coal, petroleum, natural gas, etc.) for their energy needs compared to 63% in the US.

Iceland is more of an inspiration to the world than a specific example others might follow. Damming too many rivers causes ecological damage, and not everyone lives on top of an active volcano (or, you know, would want to). But Iceland demonstrates that if a country prioritizes clean energy and works together towards that goal, over time it can be successful and reap the ecological, financial, and health benefits.

France

In how many ways can the French drink water differently than Americans? Answer: Many, many, many. To me, the most interesting part was how Eau de Paris, the publicly owned company tasked to distribute tap water to all of Paris, kills microbes in water using ozone and UV light instead of chlorine. Yes, I would also like to drink chlorine-free tap water. Let’s all do that.

In an awkwardly bizarre moment, Darin dives headlong into psychobabble by exhorting Zac to walk barefoot in the dirt to “get the electromagnetic connection to the earth.” Were they wearing iron shoes? Um, ‘cause otherwise that makes no scientific sense. “It’ll help your circadian rhythm,” Darin continues. Maybe. Probably not. But going barefoot can put you at risk for fungus, MRSA, and parasites like hookworm and jiggers (depending on where in the world you stick your bare feet). A harsh reminder to listen to podcasts at your own risk.

Costa Rica

Living the pura vida (pure life) in Costa Rica is a huge population of ex-pats (AKA immigrants), including 50-70 thousand Americans. They probably didn’t all buy huge swaths of land to form communal off-grid utopias, but the people we meet sure did. The first group consists of 44 families from multiple countries who live a lifestyle described as sustainable but clearly began with a massive influx of money. Even Zac can’t believe how nice the houses are.

Still, this rich echo-village is pretty sweet. It must be amazing to be a child growing up here, cloistered within a landscape of food and a methane digester. At least until you come of age and realize how completely disconnected you are to the reality of the modern world. Not that reality is so great. “Please enroll me for a few semesters,” Zac jokes.

The other group consists of mostly twenty-something hippies and involves herbalism, superfoods, and – I assume – plenty of sex. I kept waiting for them to drag Zac away to a private hut. Zac would have been into it (“There’s like a bunch of chicks just walking out!”), but either it didn’t happen or they spared us that scene.

On a more serious note, the Jaguar Rescue Center is impressive. Watching how the staff rescues and rehabilitates wildlife, I felt brief waves of hope for humanity wash over me.

Sardinia, Italy

Sardinia is a Blue Zone, one of the five regions of the world with the highest concentration of centenarians. I’ve cared for several patients over 100-years-old in my career to date, and I’m not convinced this is a thing anyone should strive for. But it does bring up interesting issues of nutrition and genetics.

Statistically speaking, should we accept universal health conclusions based on extreme outliers? This is a complex issue (check out this article if you get excited by esoteric math or Gaussian distributions), which Zac and Darin ignore. Still, no one can argue with their conclusion: live a low-stress, active lifestyle. Sold! Where can I get one of those?

Zac concludes that he needs to get far away from California. While he is talking specifically about Hollywood, he doesn’t need to go as far as Sardinia. Early in the episode, they show a map of the five Blue Zones and one of them is in California. Loma Linda is an hour and a half drive from LA. Zac can zip over there any time he wants. Maybe I should start a podcast so Zac can reach out to me. I’d even let him keep his shoes on.

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Lima, Peru

Here we learn about biopiracy (stealing crops from other countries), cryopreservation (doomsday vaults for crops), and genetic engineering of the food supply (GMOs). Back in Costa Rica, the commune boasted of eating “non-GMO foods” and, in a later episode, GMO foods are listed as a reason for the decline of bees. Ignoring all that, in this episode GMOs are good, and we learn how genetically altering the potato to adjust for climate change will fight famine.

This contradiction is not addressed. Zac and Darin never challenge anyone they interview, and it’s another lost opportunity. I would have liked to hear The International Potato Center’s counterargument of the criticisms of GMOs. If the controversy interests you, click the link to read what the World Health Organization has to say.

Puerto Rico

This is an emotionally intense episode as we see the devastation hurricanes Irma and Maria wrought on the island community. The issue of global climate change rears its head again, and not for the last time.

We see examples of hydroponic farming, eco-friendly tourism, and ocean sustainability. Most impressive is World Central Kitchen founded by Chef José Andrés that promotes sustainable farming and foods. They responded to the devastation in Puerto Rico by serving 150,000 meals per day and are still active, awarding Plow to Plate grant funding and operating farmer’s markets. Not discussed is how World Central Kitchen continues to respond to crises within the United States and other locations around the world. Mucho respeto.

Zac and Darin help a family discard detritus left over from the hurricane, but their biggest accomplishment is the entire point of the series: using Zac’s fame to bring attention to health and environmental problems around the world. And sign autographs. And take selfies. Zac has many skills.

London, England

England, the site of the world’s first industrial revolution, is still recovering from self-inflicted pollution and all its adverse health effects, particularly asthma and allergies. While much improved from the smog-choked days of the 1950s, London has a long way to go. We see Thames River cleanups and discuss the problems of single-use plastics. The highlight is watching Darin gush over green walls. He just loves them.

Zac and Darin site fossil fuel-burning vehicles as the main culprit. Fair enough, but considering Darin is a vegan, I kept waiting for him to discuss the environmental impact of meat consumption. They do mention it as a cause of deforestation (in a different episode), but its effect on greenhouse gas emissions, biodiversity loss, acid rain, water degradation, and coral reef degeneration are not discussed. You had eight episodes and you freaking went to the Amazon. Okay, moving on.

Iquitos, Peru

We are off to the rainforest to watch Zac and Darin get attacked by mosquitoes and fire ants. Of all the things to do in the Amazon, they focus on spirituality and medicinal plants. Sure, why not? Ayahuasca is not my thing, but now I really want to eat camu-camu.

Overshadowing the final episode are the LA fires (of 2018), which rage towards Darin’s home in Malibu while they are filming this episode. The effects of global climate change hit home for a jarringly intense ending.

Conclusion

This series is worth watching if only for the fabulous travel views and the banter between the ultra-enthusiastic Zac Efron and Darin Olien. The medical and scientific information was often good, but they made no particular effort to back anything up with studies or data and took everything anyone said at face value without any challenge. The result is a mixed bag: some of the science is accurate and urgent, some biased but close enough, and the remainder requires the disclaimer for entertainment purposes only.

Worst and best Darin quotes:

Worst: “If you keep your hydration up, your brain retains more information … grab some fresh water ‘cause you’ll be smarter and you’ll be able to read more books.”

He says this to a genius 10-year-old boy, who, one can hope, is smart enough to know that drinking extra water does not make you smarter or help you read more books. I truly don’t know where Darin gets this nonsense from.

Best: “We’re all just as exposed to anything happening at any moment.” (quote edited to remove completely warranted profanity)

He’s referring to the environmental effects of global climate change and he is dead on. Anything can happen anywhere in the world, and we are all at risk. Like Darin, I have also been personally affected by global climate change when my family was caught in a flash flood (everybody survived although my car was totaled). This is our present, not some dystopian future. Let’s hope this docuseries contributes to the movement affecting positive change.

Down to Earth with Zac Efron is available for streaming on Netflix.

About the Author

David Z Hirsch, MD is the pen name of the author of the award-winning novels Didn’t Get Frazzled and Jake, Lucid Dreamer, both available for purchase on Amazon or may be read for free with Kindle Unlimited. Didn’t Get Frazzled is also available on Audible.

He is an internal medicine physician with an active practice in Maryland.

Check out my other reviews:

A medical review of the documentary Forks Over Knives

A medical review of the documentary In Defense of Food

A medical review of the documentary The Truth About Alcohol

A medical review of the documentary Why Are We Getting So Fat?

And the video 5 Netflix Health Documentaries Worth Streaming

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Published on July 18, 2020 11:01

A medical review of the documentary The Truth About Alcohol

The Truth About Alcohol

This 2016 BBC documentary stars Dr. Javid Abdelmoneium, an A&E doctor (equivalent to an ER doctor in the US) who works at St. Mary’s Hospital in London, England. The driving force of the documentary was the change in UK guidelines that recommended a decrease in alcohol consumption to 14 units per week for both men and women. The reduction was a direct result of the new understanding of the link between alcohol use and cancer risk.

What is a unit?

The “unit” is a UK thing, created to make things simpler by adding complex math that very few people understand. According to the NHS description, a unit = the percent alcohol (ABV) x volume (ml) ÷ 1,000. Got it? For those who don’t want to whip out their calculator in pubs and bars, a small shot of liquor is 1 unit, a glass of wine is 2-3 units, and a can of beer is 2 units.

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And the US recommendations?

The 2015-2020 US Dietary Guidelines for Americans recommend that alcohol should be consumed, if at all, in moderation, defined as up to one drink per day for women and two drinks per day for men.

The CDC defines “a drink” as 12 oz of beer, 8 oz of malt liquor, 5 oz of wine, or 1.5 oz of liquor (or distilled spirits).

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Using the UK unit formula above: “a drink” converts to 1.7 – 1.8 units for each of the four examples. In addition to the difficulty in translating one drink into units, the US guidelines are for daily (not weekly) intake, making it even more challenging to compare the US and UK recommendations.

For example, if you are a woman and you drink one glass of wine daily (in unit terms, 2×7=14 units per week), you would be in compliance with both recommendations. But if you drank the 7 glasses of wine over 3 days during the week, you would be a binge drinker in the US and just fine in the UK.

And the world?

Here is an excellent article about global alcohol consumption. You can peruse the site at your leisure. Bottom line: In 2016, the average liters of pure alcohol consumed per person (over 15 years old) in the US were 9.8 vs. 11.4 in the UK. As you might expect, France was higher at 12.6. And the winner (or loser, in this case): Moldova at 15.2.

Back to the documentary (and the UK)

Throughout the documentary, we follow Dr. Javid, an amiable fellow who comes across both energetic and knowledgeable. He performs several experiments, often on himself, to answer various questions about the effects of alcohol. He’s easy to like, but an odd choice to lead a documentary purported to be about the dangers of alcohol. One of the first things we see is a measure of how much alcohol he drinks. It turns out that he is, in American parlance, a binge drinker. Even by UK standards, he drinks well over the 14 units per week goal.

And yes, Dr. Javid is a physician seeing emergencies that are often the direct results of alcohol-related tragedies like motor vehicle crashes, violence, sexual risk behaviors, stroke/heart attack from high blood pressure, and cancer. And it’s not just him: all of the scientists and physicians he interviews about the risks of drinking discuss how much they enjoy drinking. The documentary is less of a PSA and more of a party.

What are the findings?

Still, the documentary does cover a lot of ground, even if its conclusions are not especially surprising. We learn that the benefits of red wine are in polyphenols, which cause blood vessel dilation and can lower blood pressure. But then, the effect is minimal, and other foods contain polyphenols like walnuts, almonds, apples, blueberries, and dark chocolate, so you don’t need to drink wine to get them.

Alcohol is not very good for your brain, limiting multi-tasking and decision-making. It doesn’t keep you warm; it just makes you think you are warmer by causing dilation of blood vessels, which actually causes you to lose body heat. It doesn’t help you sleep but rather disrupts deep sleep. It can make you fatter from both the calories of alcohol and by increasing your appetite.

Eating before drinking will limit your alcohol absorption. The best way to improve your tolerance for alcohol is to build muscle (muscle holds more water than fat and will dilute the alcohol better). There isn’t much you can do for a hangover, although Dr. Javid makes a case for eating borage before drinking, then concedes that ibuprofen has the same anti-inflammatory effect.

Most disappointing is the conclusion that the protective effect of alcohol and heart disease is marginal for most people. For women over 55, there is a more significant benefit but only with drinking up to 5 units per week (a beer and a full glass of wine). Above that, the adverse effects outweigh its benefits.

So what was the point of all this?

The premise of the documentary is that the change in the UK guidelines is due to the link between alcohol and cancer, a connection that many understand poorly. Dr. Javid briefly discusses this at the end of the documentary, but not in nearly as much detail as it deserves considering this is new information for many people. So let’s be clear. Alcohol is linked to seven different forms of cancer: liver, breast, bowel, mouth, throat, esophageal, and laryngeal cancer.

Conclusion:

If you are interested in watching a documentary that discusses the many issues of alcohol and health, you’ve come to the right place. If you can overlook the disconnect between the drunken party atmosphere and the sobering information, maybe you’ll learn something. If not, there are worse ways to spend an hour.

Are you interested in calculating your unit intake per week? Write down every alcoholic drink you consume over the next seven days and plug it into the calculator. If you consume over 14 units a week, you are at increased risk for alcohol-related cancer. Also, high blood pressure, heart disease, stroke, liver disease, and digestive problems. Cheers!

The Truth About Alcohol is available for streaming on Netflix.

About the Author

David Z Hirsch, MD is the pen name of the author of the award-winning novels Didn’t Get Frazzled and Jake, Lucid Dreamer, both available for purchase on Amazon or may be read for free with Kindle Unlimited. Didn’t Get Frazzled is also available on Audible.

He is an internal medicine physician with an active practice in Maryland.

Check out my other reviews:

A medical review of the documentary Forks Over Knives

A medical review of the documentary In Defense of Food

A medical review of the documentary Why Are We Getting So Fat?

And the video 5 Netflix Health Documentaries Worth Streaming

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Published on March 12, 2020 15:34

A medical review of the documentary End Game

End Game

End Game is a 2018 Netflix Original documentary and an Academy Award-nominated short film about palliative care. At the University of California, San Francisco (UCSF) Medical Center, physician-led teams guide five hospice patients and their families through the end-of-life process. We watch these patients and their families struggle in real-time. As an internist with first-hand experience, I can attest that these are realistic, intimate moments, universal to all.

“Hospice means death … Do not talk about it with her.” – Vaji (Mitra’s mother)

The discussion of Mitra’s failing cancer treatment leads to recommendations of palliative care, and the family resists. Once the team determines that it is time to initiate the conversation, a heated exchange ensues.

“Still, we have (a) chance to fight, and I think we should fight.” – Hamid (Mitra’s husband)

The palliative team answers questions and allows the patients and families time to come to a consensus. As Mitra’s lucidity declines and her suffering worsens, the family is forced to confront questions no one ever wants to hear: How does she want to die (full code vs. natural death)? Where does she want to die (hospital vs. home)?

“The scary part is the unknown. And the lack of control.” – Thekla (hospice patient)

End Game is challenging, even grueling, but imperative. The more one is familiar with the process, the easier it is to cope when you are in this situation, whether as a patient or a family member.

My only criticism of the documentary is that these were all best-case scenarios. There is not one misspoken word or action. The doctors, nurses, chaplains, and social workers who make up the palliative teams express a dizzying level of empathy and skill. If I’m ever in this situation, I want all of them.

“I still believe in miracles … I don’t want to let her go.” – Hamid (Mitra’s husband)

He doesn’t want to, but ultimately, he has to; the inevitability of death demands it. What follows is a quiet but visceral moment: Mitra’s husband and 8-year-old son take turns kissing her hand while the boy slowly rubs his mother’s shaved head. We all have our demons, and mine was that I was that boy, over four decades ago and on the other side of the continent.

“There is nothing inherently medical about dying … It’s purely human.” – Dr. B.J. Miller (palliative care physician)

This documentary has no voice over. No one explains or describes anything. It just unfolds in front of you. I think this was a wise decision, and the result is a powerful documentary.

All five patients die. This is not a spoiler; it is the eventuality of hospice. After post-death discussions and funerals, the documentary ends, leaving you to grapple with your thoughts and emotions.

Conclusion

I vigorously recommend this documentary. While only 40 minutes long, End Game will stay with you for so much longer.

Visit the End Game website for more information and resources. Directed by Academy Award-winning filmmakers Rob Epstein and Jeffrey Friedman. Film by executive producer Dr. Shoshana Ungerleider, a hospice and palliative care physician.

End Game is available for streaming on Netflix.

About the Author

David Z Hirsch, MD is the pen name of the author of the award-winning novels Didn’t Get Frazzled and Jake, Lucid Dreamer, both available for purchase on Amazon or may be read for free with Kindle Unlimited. Didn’t Get Frazzled is also available on Audible.

He is an internal medicine physician with an active practice in Maryland.

Check out my other reviews:

A medical review of the documentary Forks Over Knives

A medical review of the documentary In Defense of Food

A Medical Review of the documentary Why Are We Getting So Fat?

And the video 5 Netflix Health Documentaries Worth Streaming

Like • 0 comments • flag

Published on December 08, 2019 07:22

A medical review of the documentary Why Are We Getting So Fat?

Why are we getting so fat?

Originally a 2016 episode of Horizon on the BBC, this documentary is now available to a broader audience on Netflix. The star is Giles Yeo, Ph.D., a geneticist who works at the University of Cambridge. Dr. Yeo has a droll style that engages the viewer despite periodic scientific forays into genetic minutia. Apropos to his whimsical nature, he structures his documentary as a lighthearted road trip.

The tagline states that Dr. Yeo wants to dispel “misconceptions about living with obesity,” and he does this by interviewing people to discuss their struggles with weight. His subjects come off as insightful but broken, well summed up by this quote:

“A lot of fat people, we put on a good façade. But inside, we’re crying.”

Dr. Yeo’s empathy for his obese subjects is commendable, but his defense exposes his bias. He focuses entirely on science-based causes, ignoring the multifactorial etiology of obesity even as his subjects do not, often admitting to stress eating, poor dietary choices, or a lack of exercise. Nevertheless, his scientific investigations are worth exploring.

Cambridge

We begin with Dr. Yeo’s research in Cambridge into the genetic variant FTO, an “obesity gene,” which affects the brain’s sensitivity to appetite hormones released from the gut and fat cells. All fascinating, until his decision to perform a silly “study” of dubious scientific value. Dr. Yeo tests obese subjects for FTO, tells those individuals who test positive, and then secretly records how much food they eat in a buffet spread immediately after.

Not surprisingly, these told that they tested positive eat less, but will this have a significant impact in the long run? Not even Dr. Yeo thinks so, as he admits that he worries about his girth yet has never tested himself for FTO.

Wales

We drive next to Wales to discuss bariatric surgery, which reduces the stomach size but also alters hormone secretions. How significant is the alteration of hormone secretions to weight loss? To explore this question, researchers test a cocktail of “hunger hormones” that mimic the physiological after-effects of gastric bypass surgery. Sure enough, there is a 20% reduction in caloric intake in the first meal after the injection.

So will this lead to a new treatment that doctors can prescribe? Maybe not, as they do not discuss how long the effect lasts or the cost of these injections. Also never discussed is the issue of food choices made by the subjects, an oversight repeated in every scenario throughout the documentary.

Providence, Rhode Island

Instead, we move on the Providence, Rhode Island (on our road trip, having driven over the Atlantic) to discuss gut bacteria. We meet a woman who gained four stone (54 lbs to American viewers) over 2-3 years after she received a stool transplant from her obese daughter to treat C. difficile colitis.

Could the change in gut bacteria explain her weight gain? Researchers have started human trials using stool transplants from lean donors, monitoring GLP-1 as a surrogate marker, to answer this question. Unfortunately, we move on before getting any results.

Never fear, I googled it. I found one study that showed a potential benefit and another study that did not. Yep, sounds about right. The literature on obesity treatment is rife with ambiguity. Could this be because the etiology of obesity is multifactorial?

London

Driving next to St. Thomas’ Hospital in London (returning across the Atlantic in his magic car), we explore the link of individual bacteria to weight loss. The stools in a set of twins revealed the bacteria Christensenella to be significantly more prevalent in the stool of the thin twin compared to her obese twin. Does this suggest causation? No proof of that as yet. That doesn’t stop the ever-optimistic Dr. Yeo from making this conclusion:

“I am confident that this battle against obesity will be won one day.”

Possibly, eventually, but not until we have an honest discussion of all factors. Despite addressing what he calls an obesogenic environment awash in fast food restaurants serving highly processed foods, Dr. Yeo proceeds to accept this reality as inevitable, making no effort to buy his dinner elsewhere. Watching the star of the documentary on obesity chow down on highly processed foods makes me decidedly less confident.

Conclusion:

Documentaries that address obesity and focus only on food choices run the risk of blaming obese people for their weight. This documentary suffers from the other extreme. By focusing only on genetics and diminishing or even dismissing other factors, Dr. Yeo has failed to answer his own question.

Why are we getting so fat? Obesity is a multifactorial problem involving food choices, exercise, stress/anxiety, and genetics. The documentary does an excellent job addressing the genetic aspects that contribute to obesity. But to find an answer to his question, you will need to look elsewhere.

More support that Dr. Yeo is correct about the lack of compassion given to obese people: Here are the first two comments at TheDailyMail.com following their review of this episode. Comments were cut & pasted from the website so expect derision and poor grammar:

“Of course it’s genetic fat people are stupid people and stupidity is genetic – too stupid to even tot up a few calories”

“Fabulous,just what fat people need,another’reason’why they’can’t’lose weight….”

Always heartening to see how polite Brits are just as horrid on the internet as everyone else.

Why Are We Getting So Fat? is available for streaming on Netflix.

About the Author

David Z Hirsch, MD is the pen name of the author of the award-winning novels Didn’t Get Frazzled and Jake, Lucid Dreamer, both available for purchase on Amazon or may be read for free with Kindle Unlimited. Didn’t Get Frazzled is also available on Audible.

He is an internal medicine physician with an active practice in Maryland.

Check out my other reviews:

A medical review of the documentary Forks Over Knives

A medical review of the documentary In Defense of Food

And the video 5 Netflix Health Documentaries Worth Streaming

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Published on November 03, 2019 12:11

A Medical Review of the documentary Why Are We Getting So Fat?

Why are we getting so fat?

Originally a 2016 episode of Horizon on the BBC, this documentary is now available to a broader audience on Netflix. The star is Giles Yeo, Ph.D., a geneticist who works at the University of Cambridge. Dr. Yeo has a droll style that engages the viewer despite periodic scientific forays into genetic minutia. Apropos to his whimsical nature, he structures his documentary as a lighthearted road trip.

The tagline states that Dr. Yeo wants to dispel “misconceptions about living with obesity,” and he does this by interviewing people to discuss their struggles with weight. His subjects come off as insightful but broken, well summed up by this quote:

“A lot of fat people, we put on a good façade. But inside, we’re crying.”

Dr. Yeo’s empathy for his obese subjects is commendable, but his defense exposes his bias. He focuses entirely on science-based causes, ignoring the multifactorial etiology of obesity even as his subjects do not, often admitting to stress eating, poor dietary choices, or a lack of exercise. Nevertheless, his scientific investigations are worth exploring.

Cambridge

We begin with Dr. Yeo’s research in Cambridge into the genetic variant FTO, an “obesity gene,” which affects the brain’s sensitivity to appetite hormones released from the gut and fat cells. All fascinating, until his decision to perform a silly “study” of dubious scientific value. Dr. Yeo tests obese subjects for FTO, tells those individuals who test positive, and then secretly records how much food they eat in a buffet spread immediately after.

Not surprisingly, these told that they tested positive eat less, but will this have a significant impact in the long run? Not even Dr. Yeo thinks so, as he admits that he worries about his girth yet has never tested himself for FTO.

Wales

We drive next to Wales to discuss bariatric surgery, which reduces the stomach size but also alters hormone secretions. How significant is the alteration of hormone secretions to weight loss? To explore this question, researchers test a cocktail of “hunger hormones” that mimic the physiological after-effects of gastric bypass surgery. Sure enough, there is a 20% reduction in caloric intake in the first meal after the injection.

So will this lead to a new treatment that doctors can prescribe? Maybe not, as they do not discuss how long the effect lasts or the cost of these injections. Also never discussed is the issue of food choices made by the subjects, an oversight repeated in every scenario throughout the documentary.

Providence, Rhode Island

Instead, we move on the Providence, Rhode Island (on our road trip, having driven over the Atlantic) to discuss gut bacteria. We meet a woman who gained four stone (54 lbs to American viewers) over 2-3 years after she received a stool transplant from her obese daughter to treat C. difficile colitis.

Could the change in gut bacteria explain her weight gain? Researchers have started human trials using stool transplants from lean donors, monitoring GLP-1 as a surrogate marker, to answer this question. Unfortunately, we move on before getting any results.

Never fear, I googled it. I found one study that showed a potential benefit and another study that did not. Yep, sounds about right. The literature on obesity treatment is rife with ambiguity. Could this be because the etiology of obesity is multifactorial?

London

Driving next to St. Thomas’ Hospital in London (returning across the Atlantic in his magic car), we explore the link of individual bacteria to weight loss. The stools in a set of twins revealed the bacteria Christensenella to be significantly more prevalent in the stool of the thin twin compared to her obese twin. Does this suggest causation? No proof of that as yet. That doesn’t stop the ever-optimistic Dr. Yeo from making this conclusion:

“I am confident that this battle against obesity will be won one day.”

Possibly, eventually, but not until we have an honest discussion of all factors. Despite addressing what he calls an obesogenic environment awash in fast food restaurants serving highly processed foods, Dr. Yeo proceeds to accept this reality as inevitable, making no effort to buy his dinner elsewhere. Watching the star of the documentary on obesity chow down on highly processed foods makes me decidedly less confident.

Conclusion:

Documentaries that address obesity and focus only on food choices run the risk of blaming obese people for their weight. This documentary suffers from the other extreme. By focusing only on genetics and diminishing or even dismissing other factors, Dr. Yeo has failed to answer his own question.

Why are we getting so fat? Obesity is a multifactorial problem involving food choices, exercise, stress/anxiety, and genetics. The documentary does an excellent job addressing the genetic aspects that contribute to obesity. But to find an answer to his question, you will need to look elsewhere.

More support that Dr. Yeo is correct about the lack of compassion given to obese people: Here are the first two comments at TheDailyMail.com following their review of this episode. Comments were cut & pasted from the website so expect derision and poor grammar:

“Of course it’s genetic fat people are stupid people and stupidity is genetic – too stupid to even tot up a few calories”

“Fabulous,just what fat people need,another’reason’why they’can’t’lose weight….”

Always heartening to see how polite Brits are just as horrid on the internet as everyone else.

Why Are We Getting So Fat? is available for streaming on Netflix.

About the Author

David Z Hirsch, MD is the pen name of the author of the award-winning novels Didn’t Get Frazzled and Jake, Lucid Dreamer, both available for purchase on Amazon or may be read for free with Kindle Unlimited. Didn’t Get Frazzled is also available on Audible.

He is an internal medicine physician with an active practice in Maryland.

Check out my other reviews:

A medical review of the documentary Forks Over Knives

A medical review of the documentary In Defense of Food

And the video 5 Netflix Health Documentaries Worth Streaming

Like • 0 comments • flag

Published on November 03, 2019 12:11

A medical review of the documentary The C Word

The C Word

The C Word is a 2016 documentary that advocates an integrative approach to the treatment and prevention of cancer by focusing on nutrition, exercise, stress management, and toxin avoidance. Much of the documentary is an hour-and-a-half advertisement for French physician David Servan-Schreiver’s book Anticancer: A New Way of Life, in a film produced, directed, and written by his fiercest advocate, Meghan LaFrance O’Hara.

The C Word weaves interviews, basic animation, and pop culture clips to promote Servan-Schreiver’s theories, enhanced by the velvety narration of Morgan Freeman. While tedious at times, the film maintains an emotional depth by incorporating the personal stories of the subject (Servan-Schreiver) and the author (O’Hara), both of whom battle cancer.

Randomized clinical trials are expensive and mostly funded by the pharmaceutical industry, a point that Servan-Schreiver makes to mitigate reasonable concern about the paucity of hard data supporting his many contentions. Not that this stops him from quoting the findings of less rigorous studies as unequivocal truth. Even still, he promotes an intriguing philosophy, one that falls squarely in the category of couldn’t hurt / might help.

We all have cancer

Servan-Schreiver’s most startling contention is that from a young age, we all have cancer cells, which he loosely defines as cells that have undergone mutations. Any of these cells may progress to clinically expressed cancer decades later. This paradigm shift breaks away from the conventional view that some people develop cancer while others don’t. And if we all have cancer cells in our bodies, cancer prevention becomes essential for everyone.

What he recommends

Promoting an integrative approach to cancer treatment, Servan-Schreiver is not opposed to conventional cancer treatment and also recommends the following:

Proper nutrition. Obesity creates a chronic inflammatory condition favoring cancer. He advocates a plant-based diet, especially those fruits and vegetables with phytochemicals (such as broccoli, cauliflower, cabbage, blueberries, and strawberries).
Exercise. Body systems are weakened in a sedentary state while exercise boosts the immune system. He refers to a study that shows a reduction of cancer mortality with moderate exercise (30 minutes, 6 days per week).
Stress management. Stress hormones created by chronic stress states promote cancer. He notes that everyone has stress, so the key is to manage stress effectively. One approach he discusses is 20 minutes of daily meditation.
Toxin avoidance. He discusses obvious toxins like tobacco, less obvious toxins like processed foods (especially sugar), and other toxins most people don’t even think about like those in cosmetics and hair products.

Mutual distrust

This is all good advice and worth contemplating. When Servan-Schreiver’s book first came out over a decade ago (in early 2009), it was met with scorn by many in the medical community who worried that he advanced unproven ideas while discounting effective cancer treatment and thus put the lives of patients at risk. He isn’t doing that at all, at least not in this documentary. We know he supports conventional treatment given that he elected to go through conventional treatment for his brain tumor.

The medical community changes slowly but has come to accept the importance of lifestyle changes in the management of chronic diseases (including cancer). Despite this, Servan-Schreiver accuses doctors of prescribing medication to “mask symptoms instead of preventing their causes.” This is not a zero-sum game; you can and should do both.

Conclusion

The premise of this documentary is that after O’Hara receives a diagnosis of stage 3 breast cancer, she discovers hope once she learns about David Servan-Schreiver. Her impulse is to convince him to let her make a movie about him. I can’t imagine this took much convincing since she remains uncritical and downright fawning throughout.

Nevertheless, Servan-Schreiver has a point of view that will resonate with other cancer sufferers. If you accept the presence of mutated cells in our bodies as equivalent to “we all have cancer,” then this group can be expanded to include us all. I recommend this documentary to anyone who finds this topic interesting, whatever your background or medical history.

Most deadly ironic moment: an overwhelmed Servan-Schreiver appearing stressed 30 minutes before performing his lecture on cancer reduction, where he discusses the critical need to reduce stress.

Best example of hospital lunacy: a cancer patient discusses how the hospital served him a sloppy joe after surgery for colon cancer. I have seen many examples of this, and it never ceases to appall me. The cause may be a miscommunication between services in the hospital, a lack of physician input to the dietary service, or the low priority food is given to health care in the hospital. But seriously, when would a glob of processed meat be a healthy food choice for any patient?

The C Word is available for streaming on Netflix.

About the Author

David Z Hirsch, MD is the pen name of the author of the award-winning novels Didn’t Get Frazzled and Jake, Lucid Dreamer, both available for purchase on Amazon or may be read for free with Kindle Unlimited. Didn’t Get Frazzled is also available on Audible.

He is an internal medicine physician with an active practice in Maryland.

Check out my other reviews:

A medical review of the documentary Forks Over Knives

A medical review of the documentary In Defense of Food

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Published on October 24, 2019 14:57

A medical review of the documentary Heal

Heal

Heal is a 2017 documentary by Kelly Noonan Gores that examines the power of the mind to heal the body. Taking a holistic approach to health, she focuses on chronic disease and how the mind can have a positive or negative effect on disease. While this is undoubtedly true, she takes this concept to an extreme and decides that the mind is the only thing responsible for most disease.

Various talking heads pontificate and theorize on various alternative medicine ideologies and their opinions are accepted without challenge or critical debate. The documentary relies heavily on anecdotal support but no actual studies (with one interesting exception that I will get to later). The most engaging part of this documentary is the individual stories of patients with chronic disease and emotional distress. The remainder dragged like a series of late-night infomercials.

By claiming “the ultimate cause of disease is stress” and suggesting that you can undo stress to rid yourself of cancer, Noonan Gores puts the onus on you for being sick. Pseudoscience such as heat accumulation, super-immune response, sound frequencies and the like are all equally accepted at face value while science and medicine are disparaged. This isn’t just wrong, it is unnecessary.

Treatments that do not adhere to conventional evidence-based medicine are referred to as complementary and alternative medicine (CAM). In other words, these treatments can be used along with conventional medicine (complementary) or instead of it (alternative). Most people in Western societies use it as complementary (also called integrative) medicine and that was generally the case in the anecdotes discussed in this documentary. So why the competition? Disparaging the proven benefits of conventional medicine doesn’t make CAM therapies any more or less effective. A truly holistic approach would consider all treatments and combine them in a way that best benefits each individual.

The placebo effect

CAM therapies often shy away from discussing the placebo effect, but this documentary dives right in. Placebos are defined as medications or therapies that have no therapeutic value, yet many people respond to placebos. The placebo effect, or the power of positive thinking, is the basis of CAM therapy. It is the power of belief, both in the spiritual and the non-religious sense. If you think the medical medium waving his hands over your body or the spiritual psychologist channeling the power of God can make you better, then by the power of positive thinking you may actually get better.

I found this argument a compelling explanation of why all types of CAM therapies can actually work for some individuals despite a lack of proven efficacy. For example, it explains why you may think “full body acidity” is nonsense (because it is), yet if others believe it is true, some may actually benefit.

Less compelling was the assumption that if positive thinking can heal pathology, negative thinking can cause pathology. In logical reasoning, this is the inverse and is not necessarily true. Taking this error of logical reasoning to its logical conclusion: your negative thinking is why you are sick. Blaming people for their own disease is, arguably, the documentary’s most egregious contention.

The only study in the entire documentary

Scientific studies need to prove that a given therapy is superior to placebo to be considered efficacious. Not surprisingly, the only study in the entire documentary was not placebo-controlled. Still, it was an interesting study worthy of discussion.

The investigators drew blood tests on a group of 120 people who spent 4.5 days meditating and found most of the group’s cortisol levels decreased and IgA levels increased. This is an interesting finding even if, from a medical standpoint, you can base absolutely no conclusions from it. This is because they used surrogate endpoints (cortisol is linked to stress and IgA to infection resistance but stress and infection resistance were not the endpoints measured).

There was no discussion of how long these effects lasted and no discussion of replicating the experiment (you need to do a prospective study to prove that the findings of a retrospective study didn’t occur by chance). Still, finding a potential scientific basis for positive thinking (in this case, meditation) is fascinating stuff.

Conclusion

Healing the mind and the body in tandem is crucial for managing chronic disease. This documentary does a good job exemplifying the need to do both and can be inspirational. Maligning physicians and suggesting that it is your own fault for being sick is not. Opinions are accepted without challenge or critical thought, obscuring the otherwise helpful message of addressing underlying stress as a critical factor in healing.

Most forehead-smacking moment: a woman in this documentary has a very positive response to one cycle of chemotherapy and asks her oncologist if he thinks the wheatgrass she had been drinking at the same time is responsible for her remission. Her oncologist feels the chemotherapy that had been rigorously tested in controlled studies was more likely to have helped her than the unproven wheatgrass. Obviously, there is no way to be certain who is right in this specific case since she took both at the same time. Nevertheless, her conclusion is that her oncologist is “not a very good doctor.” Sigh.

Stupidest made-up statistic: “100% of diabetes type 2 has nothing to do with genetics and everything to do with lifestyle.” – David R. Hamilton, Ph.D. (organic chemist). Most people who make up statistics know better than to pick “100%” as their number. This quote is doubly stupid given the numerous twin studies in type 2 diabetes mellitus that have demonstrated a genetic component:

Diabetes mellitus in twins: a cooperative study in Japan. Committee on Diabetic Twins, Japan Diabetes Society. Diabetes Res Clin Pract 1988; 5: 271– 280. Kaprio J, Tuomilehto J, Koskenvuo M, Romanov K, Reunanen A, Eriksson J, Stengård J, Kesäniemi YA: Concordance for type 1 (insulin-dependent) and type 2 (non-insulin- dependent) diabetes mellitus in a population-based cohort of twins in Finland. Diabetologia 1992; 35: 1060– 1067. Newman B, Selby JV, King MC, Slemenda C, Fabsitz R, Friedman GD: Concordance for type 2 (non-insulin-dependent) diabetes mellitus in male twins. Diabetologia 1987; 30: 763– 768.

Type 2 diabetes mellitus is a complex disease with multiple etiologic factors including age, race, and family history, along with lifestyle factors such as weight, activity, and diet. In any documentary when someone with undue confidence claims their simplistic idea is “100%” the case, it is best to be skeptical rather than impressed. Consider me unimpressed.

Heal is available for streaming on Netflix.

About the Author

David Z Hirsch is the pen name of the author of the award-winning novels Didn’t Get Frazzledand Jake, Lucid Dreamer, both available for purchase on Amazon or may be read for free with Kindle Unlimited.

He is an internal medicine physician with an active practice in Maryland.

Check out my other reviews:

A medical review of the documentary Forks Over Knives

A medical review of the documentary In Defense of Food

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Published on May 28, 2019 05:56

A medical review of the documentary Cowspiracy

Cowspiracy

This 2014 documentary by Kip Anderson and Keegan Kuhn addresses the impact of animal agriculture on the environment and how environmental groups tend to ignore the issue, focusing instead on other environmental problems like fossil fuels. Kip makes his case through a series of interviews interspersed with animated infographics to illustrate his conclusions. The facts he sites in the documentary like:

“Animal agriculture is the leading cause of species extinction, ocean dead zones, water pollution, and habitat destruction.”

are all listed on his website with references (this particular quote has 15 citations.)

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Kip makes a convincing case about the effect of meat, poultry, dairy, and seafood on habitat loss, greenhouse gas emissions, and water use. He doesn’t view “sustainable” options as a solution because the level of human consumption is so high, there isn’t enough land needed to satisfy demand. His conclusion is to forego all meat, poultry, dairy, and seafood in favor of a vegan diet.

Animal agriculture

His most surprising revelation is how many environmental groups do not even address the issue of animal agriculture on their websites. I decided to check the websites of the groups he names to see if anything has changed in 2019, five years later.

The WWF and Greenpeace websites do discuss the impact of animal agriculture on the environment but hedge on their recommendations. Greenpeace recommends reducing meat in your diet but does not discuss a vegetarian or vegan diet. WWF has no discussion about reducing meat or a vegetarian or vegan diet.

Fairing even worse is the Sierra Club website where the animal agriculture issue remains absent. With a search, I was able to find articles both for and against eating meat. If the comments section in these articles is any indication, I was not the only one who found this disconcerting.

Overfishing

Kip meets with Oceana and argues the quantity of fish we eat is not sustainable even with sustainable fishing techniques. They don’t even attempt to disagree with him, yet their website still recommends sustainable fishing as the solution (as of 2019).

Rainforest destruction

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Kip notes how agribusiness is the leading cause of rainforest destruction, yet most charities focus on other causes like logging, palm oil, and coal. He questions why the Rainforest Action Network would limit discussion to these causes. Performing a search on their website, I was able to find a 2015 article on animal agriculture where they conclude that “commercial agriculture drives 71% of tropical deforestation.” Yet their main website still ignores animal agriculture in its climate section.

Amazon Watch also has a 2015 article addressing animal agriculture, seemingly in response to this documentary.

Environmental groups

Understanding why environmental groups are reticent to examine this issue is less clear. One interviewee suggests that they view it as a political loser that hurts with fundraising. We meet or hear about people who have spoken out against animal agriculture and experienced lawsuits or physical harm. Kip also makes the unsupported-albeit-plausible accusation that pro-livestock groups (like the Animal Agriculture Alliance he interviews) support environmental groups to silence them on this issue the way lobbyists use money to control politicians.

Kip then segues into a section with ominous music and shadowy lighting about how by even broaching this subject he has put himself in the crosshairs. He decides that he will make the ultimate sacrifice to risk … the defunding of his documentary. This melodrama lasts several minutes and induces heavy sighs in this viewer. Maybe the tension just isn’t there for me since I know he completes his documentary and then another food-based documentary in 2017, What the Heath.

Plant-based diet

The last section discusses a plant-based diet as a truly sustainable food option in an interview with Michael Pollan (who would release his own health documentary in 2015, In Defense of Food).

Kip interviews a doctor about how a vegan diet is perfectly healthy option (I guess people were unsure of this in 2014?) Kip also discusses plant-based dairy and meat, an option that probably seemed obscure at the time but has been gaining serious traction in 2019 with companies like Beyond Meat and Impossible Foods.

Conclusion

The focus of this documentary is the heath of the planet rather than individual health, but these two issues are intimately linked. This is an eye-opening documentary on many levels. The heavy focus on interviews makes it less engaging than other films, but Kip Anderson has a unique perspective that is worth pondering. His discussion of the dangers of agribusiness and how even sustainable fishing, sustainable livestock farms, and organic dairies do not fully relieve the root of the problem – the sheer quantity of fish, meat, and dairy consumed by the world – makes a strong argument for us all to consider the limited resources of our planet and reassess what we eat.

Cowspiracy is available for streaming on Netflix.

About the Author

David Z Hirsch is the pen name of the author of the award-winning novels Didn’t Get Frazzled and Jake, Lucid Dreamer, both available for purchase on Amazon or may be read for free with Kindle Unlimited.

He is an internal medicine physician with an active practice in Maryland.

Check out my other reviews:

A medical review of the documentary In Defense of Food

A medical review of the documentary Forks Over Knives